Organization
GARY L LLEWELLYN DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY L LLEWELLYN DDS (OWNER)
(317) 291-7550
Entity
Organization
Contact information
Practice address
6211 W 30TH ST, G, INDIANAPOLIS, IN 46224-3048
(317) 291-7550
(317) 291-1746
Mailing address
6211 W 30TH ST STE G, INDIANAPOLIS, IN 46224-3057
(317) 291-7550
(317) 291-1746
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
12008920
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12008920
DDS
IN
Enumeration date
03/17/2014
Last updated
04/23/2014
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